Neurosurgical sequelae of domestic dog attacks in children

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The authors' goals in this study were to describe a series of dog attacks on children that required neurosurgical consultation and to better understand the pattern of injuries inflicted, the circumstances that place children at risk for attack, and the dog breeds involved. In addition, the authors review the surgical and medical management of these patients.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a regional Level 1 pediatric trauma center over a 15-year period.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 124 children with dog bites to the head, face, and neck were evaluated in the emergency department. Of these, 17 children (13.7%) incurred injuries requiring neurosurgical consultation. Fifty-three percent of victims were female. The mean age at the time of attack was 30 months. Twelve (71%) of the attacks were perpetrated by the family pet, and 13 (76%) occurred at the patient's home. Breeds involved in the attacks included German Shepherd, Pit Bull, American Bulldog, large mixed breed, Labrador Retriever, and Akita, with German Shepherds and Akitas being the most frequently involved. Neurosurgical injuries included nondepressed skull fracture in 5, depressed skull fracture in 10, intracranial hemorrhage in 5, cerebral contusions in 4, dural laceration in 4, pneumocephalus in 5, clinically evident CSF leak in 3, spinal fracture with complete spinal cord injury in 1, stroke in 2, vascular injury in 2, and cranial nerve injury (hypoglossal and facial nerve) in 1. Prophylactic antibiotics were administered in 16 patients (94%). Only 1 patient had a confirmed infection involving the site of injury. Neurosurgical intervention was required in 10 patients (59%) and ranged in severity from debridement and closure of a complex scalp wound to decompressive craniectomy. Neurological deficits, all of which were considered catastrophic, developed in 3 patients (18%).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Dog attacks on children requiring neurosurgical consultation commonly involve the family pet, which is usually a large-breed dog with no history of prior aggression. Neurosurgical injuries often involve the cranial vault, with depressed skull fractures being the most common injury pattern. Most patients do not suffer a neurological deficit, although catastrophic neurological injury may occur. Prophylactic antibiotics are commonly used and surgical intervention is required in the majority of cases.</jats:p></jats:sec>

Growing Skull Fracture: Case Report after Rottweiler Bite and Review of the Literature

“…Dogs are pets that are in frequent contact with children and the potential for attacks should always be recognized and guarded against. Kumar et al noted that large breed dogs are more likely to cause head and neck trauma in children [5]. Of the breeds of dogs involved in fatal human attacks, Sacks et al determined that the Pit Bull and Rottweiler are the breeds most commonly implicated in fatal attacks [6].…”

“…Dogs are the most common domestic animals known to inflict head and neck injuries in children. Kumar et al [5] recently described the neurological sequelae of dog bites to the head and neck region in 124 children. However, to the best of our knowledge, a growing skull fracture resulting from a dog bite to the head has not been described.…”

Evaluation of Pediatric Patients with Animal Bites and Rabies Suspected Exposures

“…Hayvan ısırıkları, basit yaralanmalara neden olduğu gibi, yüzeyel ve derin enfeksiyonlara, doku kayıplarına, kemik fraktürlerine, nörolojik sekellere ve sonrasında psikolojik sorunlara yol açabilmektedir 7,8 . Ancak, hayvan ısırıkları özellikle oluşturduğu kuduz riski nedeniyle önemli bir halk sağlığı sorunudur.…”

Letter to the Editor. Medicolegal aspects of craniocentric dog attacks

“…TO THE EDITOR: The recent paper by Kumar et al 2 provided an excellent overview of craniocentric dog attacks requiring neurosurgical intervention (Kumar R, Deleyiannis FWB, Wilkinson C, et al: Neurosurgical sequelae of domestic dog attacks in children. J Neurosurg Pediatr 19:24-31, January 2017).…”

“…As the authors correctly point out, the majority of dog attacks occur in the home, initiated by a pet or a dog that is known to the family. 1,2 In this situation identification of the attacking animal is not an issue, but in the case of an attack by an unknown dog, this may be of paramount importance if further attacks are to be prevented and charges are to be laid. If possible then, it may be extremely useful for those involved in identifying the dog to have photographs of the external and internal injuries prior to any surgical intervention, and for any trace evidence such as dog hair to have been signed and sealed and kept as evidence, with an appropriate chain of custody.…”